This patient is a 30-year old white, single male who is a college graduate and is employed as a salesperson. His past medical history revealed that he had always been healthy and "very athletic" until 1985 when he started to experience various joint pains, fatigue, and stiffness of the back and neck. The pain grew more persistent and so severe that he had to take a temporary medical disability leave from his job.

He was seen previously by several physicians including a "Rheumatologist". X-rays of the hands, feet, hips, shoulders, knees, elbows and neck showed changes that "suggested psoriatic arthritis, but was more consistent with rheumatoid arthritis". Degenerative changes were more pronounced in the feet and hands. Various laboratory tests ordered over a period of time showed normal blood chemistry profiles and CBC's. An urinalysis was positive for blood which cleared spontaneously on later testing. The erythrocyte sedimentation rate ("sed rate") was "elevated" while tests for the rheumatoid factor, ANA and HIV were negative. His mother, father and one brother were all alive and in apparent good health with no history of arthritis. The patient denied alcohol and tobacco use. He also stated that he had a "CAT scan of the brain" as part of his diagnostic treatment. His eventual diagnosis was "seronegative rheumatoid arthritis".